Provider Demographics
NPI:1881633113
Name:REPASY, MICHAEL (PT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:REPASY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 HUNTER ST
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:NJ
Mailing Address - Zip Code:07644-1608
Mailing Address - Country:US
Mailing Address - Phone:973-365-0445
Mailing Address - Fax:973-365-0552
Practice Address - Street 1:4 HUNTER ST
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:NJ
Practice Address - Zip Code:07644-1608
Practice Address - Country:US
Practice Address - Phone:973-365-0445
Practice Address - Fax:973-365-0552
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ755877UN9Medicare ID - Type Unspecified
NJ095114Medicare PIN